Provider Demographics
NPI:1093757890
Name:OWITZ, MATHEW SCOTT (NP)
Entity Type:Individual
Prefix:MR
First Name:MATHEW
Middle Name:SCOTT
Last Name:OWITZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:CAREMOUNT MEDICAL PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:1561 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5410
Practice Address - Country:US
Practice Address - Phone:845-231-5600
Practice Address - Fax:845-331-7160
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330792-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01903373Medicaid
NYS77719Medicare UPIN
NYA400118854Medicare PIN
NYS77719Medicare UPIN
NY90N0979533Medicare ID - Type Unspecified
NY000497005006OtherBS NORTHEAST NY
NY040426007395OtherFIDELIS
NY285138OtherWELLCARE OF NY